Early removal or avoiding the use of perioperative indwelling urinary catheters with spontaneous pneumothorax surgery.

OBJECTIVES: The study evaluated the safety and advantages of no using urinary catheters (UCs) during the perioperative period in patients undergoing spontaneous pneumothorax surgery. METHODS: Forty-one patients aged 30 years or younger who underwent spontaneous pneumothorax surgery at our hospital between January 2018 and March 2020 were screened. Patients with postoperative recurrence were excluded. Patients were divided into three groups: the indwelling UC group (n = 10, group A), the group with UC removal in the operating room before extubation (n = 23, group B), and the no UC group (n = 8, group C). Perioperative circulatory complications, UC insertion or re-insertion, and time to getting out of bed after surgery and confirmation of initial urination were investigated by group. RESULTS: There were no perioperative UC insertions or re-insertions, or perioperative circulatory problems in any group. The median time (interquartile range) required for confirmation of initial postoperative urination was shorter in groups B and C [group A: 13.5 (10.6, 17.3) vs group B: 6.0 (5.0, 6.8) vs group C: 5.5 (3.8, 6.8) h; p = 0.01]. However, the time to getting out of bed after surgery was not significantly different [10.5 (6.4, 15) vs 6.0 (5.0, 7) vs 5.0 (3.8, 8) h; p = 0.12)]. Multivariable analysis showed that group A had a significantly different time to confirmation of initial urination (p = 0.001). CONCLUSIONS: Postoperative and intraoperative avoidance of indwelling UC use is acceptable in spontaneous pneumothorax surgery that satisfies certain conditions. Avoiding UC use has the potential to improve the patient experience and facilitate postoperative management.

Serum levels of candidate microRNA diagnostic markers differ among the stages of non-small-cell lung cancer.

Circulating microRNAs (miRNAs) are promising markers for cancer diagnosis and prognosis. Numerous studies evaluating miRNAs as markers for non-small cell lung cancer (NSCLC) have been conducted in recent years; however, the majority of candidate markers proposed via individual studies were inconsistent and no marker miRNAs for the diagnosis of early stage NSCLC have been established. In the present study, miR-145, miR-20a, miR-21 and miR-223, which were previously reported as candidate diagnostic markers of NSCLC, were re-evaluated. The serum levels of these miRNAs were quantified in 56 patients with stage I-IV NSCLC using the TaqMan microRNA assays and separately compared the levels at each stage with those in 26 control patients. The level of miR-145 was significantly reduced in patients with NSCLC, regardless of clinical stage, and its level increased following tumor resection in patients with stage I-II disease. These results indicate that miR-145 is relevant as a diagnostic marker for stages I-IV NSCLC. Additionally, the levels of miR-20a and miR-21 demonstrated notable differences among patients at different clinical stages. These miRNAs distinguished patients in a number of, but not all, stages of NSCLC from cancer-free control patients. These results indicated that it is essential to analyze miRNA levels at each stage separately in order to evaluate marker miRNAs for NSCLC diagnosis.

Giant bulla formation in the lung because of a check-valve mechanism.

The pathogenesis of bulla formation has not yet been demonstrated in pathologic examinations or through direct visualization during thoracotomy or thoracoscopic surgery. We present two cases of giant bulla formation after pneumothorax because of cryptogenic organizing pneumonia and lung abscess. The case findings suggested that the pathogenesis was attributable to a check-valve mechanism, secondary to bronchiolitis obliterans, or the presence of an obstructing air leakage due to a lung fistula. The lung fistula had been covered by inflammatory membranes consisting of blood and/or fibrous precipitates with detached visceral pleura.

Thoracoscopic modified pleural tent for spontaneous pneumothorax.

OBJECTIVES: We developed a modified pleural tent (m-tent) procedure and used it in our hospital in almost 30 consecutive patients with spontaneous pneumothorax. The objective of this study was to clarify the feasibility and effectiveness of a thoracoscopic m-tent for the treatment of spontaneous pneumothorax. METHODS: From July 2013 to November 2014, 107 patients with spontaneous pneumothorax were treated in our institution. Eighty-nine of these patients were analysed retrospectively. The inclusion criteria for thoracoscopic m-tent for spontaneous pneumothorax were multiple and widespread bullae, postoperative relapse and secondary spontaneous pneumothorax. The surgical procedures were usually performed through three ports. After bullectomy, an m-tent is made to strip the parietal pleura off the chest wall from about the level of the fourth or fifth rib to the apex, and two or three ligations are then applied to fix the pleural tent and lung parenchyma. Patients in whom an m-tent was not indicated underwent bullectomy plus coverage using absorbable materials. RESULTS: Twenty-seven patients underwent bullectomy plus m-tent (m-tent group) and 62 underwent bullectomy plus coverage over a staple line using an absorbable material such as a polyglycolic acid sheet or nitrocellulose sheet (coverage group). No severe postoperative complications were observed in either group. The m-tent and coverage groups showed significant differences in operation time (129 vs 86 min, mean), haemorrhage (12.8 vs 7.2 ml), postoperative hospital stay (3.7 vs 2.9 days) and postoperative painkiller intake (8.6 vs 6.8 days). Recurrence was observed in 1 (3.7%) and 2 patients (3.2%), respectively. CONCLUSIONS: The thoracoscopic m-tent procedure requires a longer operation, a longer hospital stay and greater painkiller intake. However, these differences are acceptable, and an m-tent should be considered as an option for pleural reinforcement in spontaneous pneumothorax, especially in patients who are complicated with severe pulmonary emphysema, widespread bullae or recurrent pneumothorax.

[Lung cancer surgery with combined resection of the chest wall].

Lung cancer invading the chest wall is classified as T3 in the TNM classification, and surgical resection is the first choice of treatment if it is resectable. Factors affecting survival are still unclear except for the completeness of resection and degree of lymph node involvement. Recently, multidisciplinary treatments that include induction chemoradiation followed by surgery for superior sulcus non-small cell lung cancers have been reported with favorable results. Similarly, there is an ongoing phase II study of preoperative chemoradiotherapy for lung cancer with chest wall invasion, the results of which are expected soon. Based on recent evidence, platinum-based adjuvant chemotherapy after complete resection should be considered. We present strategies and techniques for radical combined resection of the chest wall, especially resection of the rib heads with chisels, and reconstruction with prostheses.

Cytomegalovirus pneumonia in a patient with interstitial pneumonia and Nocardia asiatica presenting as cavitary lung lesions.

A 66-year-old man who suffered from an acute exacerbation of interstitial pneumonia developed a cavitary lesion after taking immunosuppressive drugs. He was diagnosed with cytomegalovirus (CMV) pneumonia. CMV was not thought to be the underlying cause of the cavitary lung lesions, as only six cases have been described thus far. However, this case clearly demonstrates that the development of cavitary lung lesions can be caused by CMV. Following CMV pneumonia, cavitary lesions again occurred in the patient's lungs that were thought to be the first case of cavitary lesions caused by Nocardia asiatica infection.